Comprehensive Formulary 2020 | Formulary Link for 2020

  • Instructions on how to Find a Drug on the Formulary (click here)

Request a Formulary

What is the Passport Advantage (HMO SNP) Formulary?

A formulary is a list of covered drugs selected by Passport Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Passport Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Passport Advantage network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.


Please note, in 2020, click here for a list of covered Diabetic Supplies and Pen Needles for Passport Advantage (HMO SNP).

As a member of Passport Advantage you are eligible to receive a monthly allowance of $20.00 in select Over-the-Counter (OTC) products up to the allowable benefit amount.

OTC medications are trusted as a first line of defense in treating minor ailments, help reduce doctor visits and save you money. Passport Advantage is committed to providing this program to you as a benefit to help you live a healthy lifestyle and improve the quality of your life.

The following categories are available with your program: (click here for the 2020 Over-the-Counter (OTC) Order Form)

  • Pain relief
  • Digestion/Laxatives/Antacids
  • Cough/Cold/Allergy
  • Anti-Hemorrhoidals
  • Anti-Fungals
  • First Aid
  • Dental
  • Ear & Eye Care

For the Order Link, click here

For the 2020 FAQ, click here










Last Modified: September 10, 2020